1742 TREATMENT OF AIDS ASSOCIATED LYMPHOID INTERSTITIAL PNEUMONITIS WITH INTRAVENOUS GAMMAGLOBULIN AND PREDNISONE

6 children with Acquired Immunodeficiency Syndrome and biopsy proven lymphoid interstitial pneumonitis were treated on a protocol of intravenous gammaglobulin and corticosteroids. Indications for therapy were a clinical history of severe and/or recurrent episodes of respiratory distress responsive to intravenous antibiotics and hypoxemia persisting after resolution of the acute illness. Hypoxemia was defined as a pO2>70 torr on three determinations. Therapy consisted of an initial period of loading with intravenous gammaglobulin. Duration and dosage of loading varied with the severity of the clinical circumstances. Corticosteroids were then initiated at 1-2 mg/kg/day and tapered to 0.75-1.0mg/kg on alternate days within 6-8 weeks. Prior to therapy the mean alveolar-arterial oxygen gradient (AaDO2) was 47 torr and the mean pO2 was 52 torr. After one month of therapy the mean AaDO2 was 21 torr and pO2 was 80 torr. At three months follow-up AaDO2 was 15 torr and pO2 79 torr. In the two patients treated for twelve months, AaDO2 and pO2 remained stable at 16 torr and 89 torr respectively. In vitro immunologic responses were not suppressed by the alternate day corticosteroid treatment.